When Ed Wilbourne attended the annual meeting of the American Podiatric Medical Association (APMA) in Washington, DC, a couple of years ago, he was eager to see what had changed in the world of foot orthoses since his previous visit 20 years earlier.
The big surprise? Not much had.
“I saw that there was significant opportunity for innovation and advancement,” said Wilbourne, who is orthopedic product and business development manager for medi USA, the American subsidiary of medi, a German O&P company based in Bayreuth that has long specialized in compression wraps and braces.
Partly as a result of Wilbourne’s inspirational moment, the US-based branch, located in Whitsett, NC, is launching a new foot and ankle division that will focus on several of the parent company’s products that have already established an enviable track record in Europe.
The company will emphasize an advanced, easily customizable carbon-fiber insole series known as the igli, as well as new products for ankle and Achilles tendon support.
“The weaknesses of current carbon-fiber orthosis designs is that they tend to be very rigid and difficult to adjust, and they do a lot of work for the foot that the foot should ideally be doing on its own,” Wilbourne said. “The igli orthoses are designed to be more easily adaptable to the patient’s expectations, activity level, and biomechanical requirements.”
The foundation of the orthosis is a lightweight carbon-fiber “clip,” in the company’s terminology. It’s roughly a three-quarter length and incorporates thin incisions that help combine optimal control with flexibility, instead of immobilizing the foot. The carbon component is bonded to a cushioned footbed; on the bottom, at the interface with the shoe, are 3D, domelike EVA (ethylene vinyl acetate) pads, available in varying densities and adhered by Velcro, that can be positioned in the clinic, essentially as postings, for optimal biomechanics and fit.
“We’re working off of the concept of sensory motor input, so that when you stand or when you’re moving, those little dots will provide feedback to the body through the plantar portion of the foot, adjusting both your gait and balance,” Wilbourne explained. “If you change shoes, or move from one style of running shoe to another, you can go back to your orthotic fitter, who can make minor adjustments to get it to fit the new shoe very easily. The clinician has the ability to make adjustments, and the patient can walk into the clinic, then leave a few minutes later with their orthoses custom-tailored to their needs.”
The line comprises several versions of the insoles, all of which have heat moldable carbon clips (at temperatures from 140° to 180° C). The igli Allround is the most popular, has been available in Germany for several years, and is designed for the widest range of applications. According to Wilbourne, it forms a foundation for runners and other active wearers. It comes in standard and light versions, as well as a C+ model with a thicker carbon clip for people who weigh more than 200 pounds.
Some models address specific pathologies. For example, the igli Control is for those with hallux rigidus or related arthritic conditions; the carbon clip is a little longer and extends under the metatarsal heads. The Heel Spur model uses a dual-durometer insole and a soft silicone insert under the sensitive area of the calcaneus.
In other cases, specific models are designed for particular demographics, professions, or sports requirements. The igli Comfort features extra padding under the metatarsals and is designed for people who tend to be on their feet all day, particularly those older than 50 years. Similarly, a new model called the igli Active is for those who spend significant time standing—hikers, construction workers, police officers, and the like. In the same vein, the igli Hardboot is for rigid sports applications such as ski boots.
In contrast, the igli Slim is designed for wear with tight-fitting athletic shoes (think soccer). There is also a Business model designed with a shallower calcaneal cup for low-volume footwear; separate versions fit men’s or women’s business and dress shoes. And the igli Junior, for pediatric applications, was the first product in the line.
medi USA’s new ankle products build on the company’s long tradition of compression stockings but add a number of innovative features, said Wilbourne. The Achimed offers silicone inserts that encapsulate the Achilles tendon, as well as a heel insert to lift the calcaneus.
“It’s designed for patients with Achilles tendinitis or injury, who may be dealing with edema and mild instability,” he said. “It provides compression so that, as you move through your range of motion, the soft tissue is massaged by the silicone inserts to help alleviate the edema.” The related Levamed is a more aggressive model with straps that control inversion and eversion.
medi USA plans to roll out the new orthoses and ankle braces at the next meeting of the North Carolina Foot & Ankle Society in January 2014 in Greensboro. The national rollout will continue from there, culminating at the APMA meeting in Honolulu next July.
Cary Groner is a freelance writer in the San Francisco Bay Area.